Sunday, February 17, 2019

The diagnostic
criteria for autism spectrum disorder (ASD) include persistent deficits in
social communication and social interaction across multiple contexts. Problems with the pragmatic/social use of language or impairment in the ability to
understand and use language in social-communicative contexts is a core feature of ASD. Pragmatic skills involve:
(a) using language for different purposes; (b) changing language according to
the needs of a listener or situation; (c) understanding non-literal language;
and (d) following rules for conversations.

There are many unwritten rules in society that
govern our behavior. While most of us intuitively understand these rules, many autistic individuals have not automatically learned the conventions and nuances
that make up their social environment. These unspoken or “hidden” social
standards can make the world a confusing place and result in life-long challenges.
For example, social expectations such as “it is not polite to interrupt others
while they are talking,” “take turns in conversation” and “discuss other topics
besides only those you are interested in” are not taught and are assumed to be
known and understood. We seem to have an “unconscious” navigator that allows us
to make intuitive sense of the unspoken rules in society and adjust to the
social demands of our everyday lives.

Unspoken Rules

The unspoken rules of
social engagement involve the use of the pragmatic, social communicative
functions of language (e.g., turn taking, understanding of inferences and
figurative expressions) as well as nonverbal skills needed to communicate and
regulate interaction (e.g., eye contact, gesture, facial expression). This
includes body language and idioms, metaphors, or slang – phrases and meanings
that we intuitively assimilate or learn through observation or subtle cues.
Individuals with autism tend to interpret language literally and may be puzzled by
the common everyday expressions used by a typical peer or adult. They may fail to
use appropriate nonverbal communication skills, such as eye contact and have
impairments in comprehension, or generally have difficulty communicating with
others. As a result, peers often feel ineffective when engaged in social exchanges
with a child on the autism spectrum and may avoid that person and/or react in a
negative way (e.g., teasing or bullying), further impacting the development of
appropriate social skills.

Consider how
idioms or figurative speech such as “how the cookie crumbles,” “curiosity
killed the cat,” "kill two birds with one stone," "everything but the kitchen sink," and “when it rains, it pours” will have a totally different
meaning and result in confusion if taken literally. In order to understand
language, we must understand what the idioms in that language mean (there are well over 3,000 idioms in the English language). If you try
to figure out the meaning of an idiom literally (word by word), you will be
bewildered. While the typical individual might understand that the phrase
“that’s the way the cookie crumbles,” and accompanying body language (e.g.,
voice, body) communicates to the listener that something unfortunate has
happened, to someone with a pragmatic social-communication problem, this idiom
will have a completely different meaning and be confusing.

Assessment

Because social
communication deficits are among the core challenges of ASD, a best practice
student assessment should include an evaluation of pragmatic competence and not
be limited to the formal, structural aspects of language (i.e., articulation
and receptive/ expressive language functioning). As a group, more capable autistic students tend to demonstrate strength in formal language, but a
weakness is pragmatic and social skills. As a result, they often fail to
qualify for speech-language services because they present strong verbal skills
and large vocabularies, and score well on formal language assessments. A variety of
assessment strategies should be used, including direct assessment, naturalistic
observation and interviewing significant others, including parents and
educators, who are valuable sources of information.

Assessments
to identify pragmatic language deficits tend to be less well developed than
tests of language fundamentals. There are fewer standard measures available to
assess these skills in children with autism. Valid norms for pragmatic development
and objective criteria for pragmatic performance are also limited. Among the
standardized instruments that focus on the social communicative functions of
language are the Comprehensive Assessment of Spoken Language (CASL;
Carrow-Woolfolk, 1999), Test of Pragmatic Language, 2nd Edition (TOPL-2;
Phelps-Terasaki & Phelps-Gunn, 2007), Social Language Development
Test-Elementary (SLDT-E; Bowers, Huisingh, & LoGiudice, 2008), Children's
Communication Checklist, Second Edition (CCC-2; Bishop, 2006) and Pragmatic
Language Skills Inventory (PLSI; Gilliam & Miller, 2006).

It is imperative that speech/language services for children with autism include particular
attention to the pragmatic, social communicative functions of
language (e.g., turn taking, understanding of inferences and figurative
expressions) as well as to the nonverbal skills needed to communicate and
regulate interaction (e.g., eye contact, gesture, facial expression, and body
language). Significant and severe deficits in the ability to communicate and
interact with others can limit participation in mainstream academic
settings and community activities. Moreover, pragmatic deficits tend to become
even more obvious and problematic as social and educational demands increase
with age. Students with pragmatic language deficits who do not meet the DSM-5 ASD criteria for restricted, repetitive patterns of behavior should be evaluated for social (pragmatic) communication disorder (SCD).

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